Public Health

Better survival at level I trauma centers after most-severe injuries

Last Updated: 2005-10-24 15:00:29 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Survival after the most severe injuries is significantly better at level I trauma centers than at level II trauma centers, according to a report in the October Annals of Surgery.

"Although it is the first study to show this difference, it is not an unexpected finding," Dr. Demetrios Demetriades from University of Southern California, Los Angeles, told Reuters Health. "Level I centers are academic facilities with stricter requirements and more resources."

Dr. Demetriades and colleagues compared outcomes of 12,254 trauma patients with specific severe injuries after treatment at level I or level II trauma centers. The injuries included aortic, vena cava, iliac vessels, grade IV or V liver injuries, penetrating cardiac injuries, quadriplegia and complex pelvic fractures.

Overall mortality among patients treated at level I trauma centers was 25.3%, the authors report, compared with 29.3% at level II trauma centers. After adjustment for injury severity scores, the mortality at level I trauma centers was nearly 20% lower than that at level II trauma centers or all other centers.

The difference was most apparent for patients with severe liver injuries or cardiovascular injuries, the results indicate; there was no survival difference for patients with quadriplegia or complex pelvic fractures.

Functional outcomes at discharge were better overall at level I centers, the researchers note, with a significantly lower incidence of total functional independence in survivors (20.3%) compared with level II centers (33.8%).

The volume of severe trauma did not influence mortality at level I or at level II centers, the report indicates.

"The current study has provided strong evidence that American College of Surgeons-designated level I trauma centers have significantly better survival and functional outcomes than level II or other trauma centers for select severe injuries," the authors write. "This finding may have practical implications in the planning of trauma systems, triage of patients to trauma centers, and financial compensation of services according to level of center accreditation."

"The public must understand that both level I and II trauma centers are essential for an effective trauma system," Dr. Demetriades added. "Logistically and practically you need to have both levels. The injuries that benefited from level I centers are only about 1% of all trauma admissions. It is not advisable to build a trauma system based exclusively on this 1% of the victims."

Ann Surg 2005;242:512-519.